Treatment and follow up of iron overload in pediatric cancer patients
Presence of hepatic siderosis was associated with utilization of iron-reducing therapy (p <0.0001), and the type of therapy (phlebotomy, chelation, or both) appeared to correlate with LIC (Figure 2).
Seventeen percent of subjects were treated with phlebotomy, 34% with chelation, and 6% with both therapies. Subjects who received chelation had higher LIC on average than subjects who received phlebotomy (p=0.0356), but the sample size was not large enough to detect a difference between those who received both chelation and phlebotomy versus those who received either phlebotomy or chelation. Treatment duration was a mean of 1.1 years for either phlebotomy or chelation, while subjects treated with both were on therapy for a mean of 3.2 years. Follow up MRI was available in 60% of treated subjects and all but five demonstrated a reduction in LIC. The rate of reduction was greater with chelation than with phlebotomy, and greater still with both modalities, although these differences were not statistically significant (Figure 3A). Pancreatic iron was generally higher in subjects treated with chelation, leading to a much greater rate of reduction than with other iron removing therapies (Figure 3B).